This exploratory study aimed to enhance an understanding of basic sociodemographic characteristics and their relation to clinical features of eating disorders. Our results emphasize notable distinctions as well as similarities across groups. In this sample, eating disorders are clearly associated with educational attainment. Although there were no significant differences across eating disorder subtypes on level of education, as a group, women with eating disorders were less educated than controls. This result is somewhat surprising given the perfectionistic and achievement-oriented nature of individuals with eating disorders and their families,52, 53
anecdotal accounts of AN being strongly associated with a drive to achieve,54
suggestions of academic overachievement in adolescents with AN,10
and evidence of higher than average IQ scores in eating disorders patients compared with controls.55
Reasons for lower levels of education in women with eating disorders are unclear. Speculatively, neurocognitive impairments associated with more entrenched illness,56, 57
deficits that persist after clinical recovery,15
and adverse effects of illness burden on various aspects of academic functioning may play a role. Accordingly, we found shorter duration of illness to be associated with higher educational attainment, and earlier age at onset to be associated with lower educational attainment. However, we cannot definitively conclude that eating disorders alone impact education. Comorbid anxiety58
and mood disorders39
often accompany eating problems and impact overall functioning.
An unexpected finding was the lack of significant differences in relationship status between women with eating disorders and controls, especially given the healthy nature of our screened controls. Reports exist that are inline with our observations.17, 59
Women with eating disorders appear to be engaging in relationships, divorcing, and remaining single at rates relatively similar to healthy women.
As it is often assumed that women with eating disorders are less likely to reproduce, our finding that irregular menstruation is associated with childlessness is noteworthy. Menstrual irregularities in eating disorders are heterogeneous and clearly do not only occur in AN. Menstrual dysfunction can occur prior to appreciable weight loss and is associated with excessive exercise, polycystic ovary syndrome, binge eating and other biological and psychological factors60
In our sample, a history of menstrual irregularity was more strongly associated with reproductive status than eating disorder subtype. Even so, there were no significant between group differences in reproductive status. Menstruation is one of many factors influencing conception and birth of child; personal desire, dedication to career or education, strained partnerships, diminished libido, partner infertility, personal commitments, and family stressors are also relevant. Despite clear differences on illness parameters across eating disorders groups, the observed differences did not generalize to the sociodemographic domains.
We acknowledge limitations to our study. First, the study was descriptive and cannot explain the reasons for a lack of observed differences, the causes of observed differences, why some observed differences do exist, or their implications for women with eating disorders and their families. Our data are also limited in that we are unable to address actual academic performance, pregnancy complications, or quality of relationships. Future research using more nuanced assessments is required to complete our understanding of the impact of eating disorders on these facets of life. This sample was ascertained for participation in a genetics study. Factors influencing participation such as coming from a family with more than one eating disorder case or willing family participation may have introduced unknown bias into the sample. Similarly, the exclusion of current Axis I disorders in our comparison group makes the control sample healthier than the general population, rendering the lack of differences between women with eating disorders and controls even more remarkable. Finally, our sample was heterogeneous in terms of course of illness. Participants with lifetime diagnoses were sampled including both currently or formerly affected individuals. Illness severity may be better than diagnosis as an index of social functioning, and comparing affected versus recovered women could provide a fuller understanding of the impact of eating disorders on sociodemographic characteristics.
With these caveats in mind, this study’s strength lies in examining sociodemographic characteristics in a large, well-defined cohort of women with and without eating disorders. One aim was to identify differences among and between the eating disorder subtypes on sociodemographic variables. Notably, relationship, reproduction, and education did not differ among women with eating disorders regardless of subtype. This finding counters some general misconceptions and stereotypes, particularly about women with AN not marrying or having children.33
In these core social categories reflective of often desired milestones, women with eating disorders appear relatively similar.
Although eating disorders are indubitably severe, they do not preclude women from leading lives that at least ostensibly resemble unaffected women in terms of relationship and reproductive status. Our findings suggest we have a limited understanding of the multidimensional nature of the lives of women with eating disorders. In addition to the typical focus on symptom resolution, future research on outcome of eating disorders should carefully assess a full array of domains of functioning in order to provide a comprehensive evaluation of course of illness and quality of life.